Alkylation of sperm DNA is associated with male factor infertility and a reduction in the proportion of oocytes fertilised during assisted reproduction.

Approximately one-third of IVF cases in the UK are attributed to male factor infertility and in the majority of cases the origin of male infertility is unknown. The integrity of sperm DNA is important both for the success of assisted reproduction and the implications for the off-spring. One type of DNA damage that has not been investigated with respect to fertility outcomes is the adduct N7-methyldeoxyguanosine (N7-MedG), a biomarker for exposure to alkylating agents. A prospective cohort of couples attending for IVF had their N7-MedG levels in sperm measured using an immunoslot blot technique to examine whether sperm N7-MedG levels are associated with male factor infertility, semen quality measures or assisted reproduction outcomes. Sufficient DNA for analysis was obtained from 67/97 couples and N7-MedG was detected in 94% of sperm samples analysed. Men diagnosed with male factor infertility had significantly higher mean levels of N7-MedG in their sperm DNA (P=0.03). Logistic regression analysis showed that N7-MedG levels were significantly negatively associated with the proportion of oocytes successfully fertilised irrespective of the method of fertilisation used (IVF or intra-cytoplasmic sperm injection; ICSI, P<0.001). Therefore exposure to DNA alkylating agents is significantly associated with male infertility and the proportion of oocytes fertilised during assisted reproduction. Reducing such exposure may improve male fertility but further work is required to determine the relative importance of exogenous and endogenous sources of exposure.

Dietary variables associated with DNA N7-methylguanine levels and O6-alkylguanine DNA-alkyltransferase activity in human colorectal mucosa.

Components of human diets may influence the incidence of colorectal adenomas, by modifying exposure or susceptibility to DNA-damaging alkylating agents. To examine this hypothesis, a food frequency questionnaire was used to assess the diet of patients recruited for a case-referent study where biopsies of normal colorectal mucosa were collected during colonoscopy and subsequently analysed for DNA N7-methylguanine (N7-MeG) levels, as an indicator of exposure, and activity of the DNA repair protein O6-alkylguanine DNA-alkyltransferase (MGMT), as an indicator of potential susceptibility. Cases with histologically proven colorectal adenomas (n = 38) were compared with referents (n = 35) free of gastrointestinal neoplasia. The case group consumed significantly more red meat (4.5 versus 3.4 servings/week, P < 0.05), processed meats, (4.7 versus 3.2 servings/week, P < 0.05) and % food energy as fat (34.9 versus 30.7%, P < 0.001). N7-MeG [mean: 95% confidence interval (CI)] levels were significantly lower in the group that consumed the highest proportion of dietary fibre/1000 kcal in comparison with the group with the lowest intake (0.61; 0.35-0.86 versus 1.88; 0.88-2.64 micromol/mol dG, P < 0.05). N7-MeG levels were also inversely associated with folate consumption (P < 0.05). MGMT activity (mean; 95% CI) was significantly higher in the group with the lowest consumption of vegetables than in the group with the greatest vegetable consumption (7.02; 5.70-8.33 versus 4.93; 3.95-5.91 fmol/microg DNA, P < 0.05). Our results are consistent with the hypothesis that dietary factors may modify exposure or susceptibility, respectively, to DNA damage by alkylating agents.

Human colorectal mucosal O6-alkylguanine DNA-alkyltransferase activity and DNA-N7-methylguanine levels in colorectal adenoma cases and matched referents.

BACKGROUND AND AIMS: O(6)-alkylguanine DNA-alkyltransferase (MGMT) provides protection against alkylating agent-induced GC-->AT transition mutations. Such mutations are frequently seen in the KRAS oncogene of large colorectal adenomas, but whether adenoma or mutational risk in humans is influenced by MGMT activity and alkylating agent exposure is unclear. Hence, MGMT activity and, as an indicator of alkylating agent exposure, DNA-N7-methylguanine (N7-MeG) levels were determined in the normal tissue of patients with and without adenomas. METHODS: Biopsy specimens of normal colorectal mucosa were collected during colonoscopy from 85 patients with histologically proved colorectal adenomas (cases) and from 85 patients free of gastrointestinal neoplasia (referents) matched by age, sex and biopsy location. MGMT activity and N7-MeG levels were measured in colorectal tissue extracts and DNA, respectively. RESULTS: MGMT activity was higher in the normal mucosa of cases than in referents (6.65+/-3.03 vs 5.61+/-2.74 fmol/micro g DNA, p = 0.01). On stratification of cases, MGMT activity was found to be considerably greater in the normal mucosa of cases with large adenomas (p = 0.003) and slightly higher in cases with a GC-->AT transition mutation in the K-ras gene (p = 0.03). Elevated MGMT levels were associated with an increased risk of adenoma (OR 1.17, 95% CI 1.03 to 1.33 per unit increase in activity). Detectable levels of N7-MeG were found in DNA from 89% of cases and 93% of referents, with levels ranging from <0.1 to 7.7 micro mol/mol dG. Cases and referents had similar DNA-N7-MeG levels. CONCLUSIONS: Human exposure to methylating agents is widespread. MGMT activity is increased in the normal mucosa of patients with adenomas.

Levels of the DNA adduct, N7-methyldeoxyguanosine, are associated with increased risk of failure of treatment of cervical intraepithelial neoplasia.

OBJECTIVE: To determine whether exposure to methylating agents was a risk factor for treatment failure in women undergoing colposcopic examination. METHODS: Nine hundred fifty-eight women attending for colposcopic examination after abnormal cervical smear test results were recruited into the study cohort. Information on demographic factors, smoking and other risk factors was obtained and a pre-treatment biopsy was taken and stored at -70 degrees C. After follow-up, cases who had treatment failure of cervical intraepithelial neoplasia (CIN) within 2 years following treatment were identified (n = 77) and matched to women with no treatment failure of CIN in this time period (controls, n = 154). DNA was extracted from the pre-treatment biopsies and levels of N7-methyl-deoxyguanosine (N7-MedG), a marker of exposure to methylating agents, were quantified as the ring-opened form of the base damage by a validated immunoslotblot assay. RESULTS: Sufficient DNA for N7-MedG analysis was extracted from 61 subjects corresponding to 20 matched case control pairs. N7-MedG was detected in cervical DNA with levels ranging from non-detected (<0.1 micromol/mol dG) to 4.83 micromol/mol dG. N7-MedG levels were significantly higher in cases (geometric mean 0.99 micromol/mol dG) than controls (0.33 micromol/mol dG; P = 0.01). There were no associations between N7-MedG levels and HPV or smoking status. Log N7-MedG content, after adjustment for HPV status at time of treatment, was found to be significantly associated with increased risk of treatment failure (OR 5.74, 95% CI 1.05-31.23). CONCLUSIONS: The association between pre-treatment levels of DNA damage induced by methylating agents and subsequent treatment failure implicates methylating agent exposure as a causative factor in treatment failure.

Longitudinal variation in O(6)-alkylguanine DNA-alkyltransferase activity in the human colon and rectum.

In a systematic study of O(6)-alkylguanine DNA-alkyltransferase activity in the human colon and rectum, tumours were found to occur in regions of low activity. These results are consistent with the hypothesis that O(6)-alkylguanine DNA-alkyltransferase levels and alkylating agent exposure may be important determinants of large bowel tumorigenesis.

Development and application of a sensitive and rapid immunoassay for the quantitation of N7-methyldeoxyguanosine in DNA samples.

N7-Methyldeoxyguanosine (N7-MedG) in DNA is a biomarker of exposure to environmental and endogenous methylating agents and may be of use in epidemiological studies. To quantitate N7-MedG in human samples, a sensitive assay system that uses only small quantities of DNA (<10 microg) is required. To this end, polyclonal antibodies against the imidazole ring-opened form of N7-MedG have been used to develop a highly sensitive immunoslot blot (ISB) assay. The limit of detection of the assay is 0.10 micromol of N7-MedG/mol of deoxyguanosine (dG) using 1 microg of DNA per analysis. The method was optimized using in vitro-methylated calf thymus DNA and then applied to a study of DNA methylation in liver and brain tissues of mice following a single iv dose of the antitumor agent Temozolomide. The amount of N7-MedG in both tissues was strictly proportional to dose over a range of 10-200 mg of Temozolomide/kg of body weight. The ISB assay was then validated using pyloric DNA of rats treated with N-methyl-N'-nitro-N-nitrosoguanidine and DNA samples from human bladder tumors, for both of which N7-MedG levels had already been quantitated by an HPLC/(32)P-postlabeling method previously described. The results showed a high degree of correlation (r = 0.98) between the two assays. The ISB assay was then applied to a range of human samples. A series of peripheral blood mononuclear cell DNA samples from cancer patients following treatment with Temozolomide had levels of N7-MedG ranging from 0.22 to 320 micromol/mol of dG. DNA samples from colon carcinoma and normal colorectal mucosa from individuals not known to be exposed to methylating agents contained levels of 0.11-1.34 micromol of N7-MedG/mol of dG. The ISB assay offers the potential for the rapid and high-throughput analysis of DNA obtained from routine biopsies and blood samples, thus enabling the determination of the extent of human exposure to environmental and endogenous sources of methylating agents in large-scale biomonitoring studies.

Optimizing sensitivity of the human sperm motility assay for embryo toxicity testing.

The human sperm motility assay was used as a measure of quality control in the IVF laboratory. The effects of albumin supplementation and incubation time on the sensitivity of the human sperm motility assay were investigated. The assay was also compared with mouse embryo development. The human sperm motility assay and mouse embryo development assays were performed on 25 items commonly used in IVF laboratories. Sperm motility assay was conducted after 2, 4, 6, 8, 24 and 48 h incubation intervals under standard embryology conditions. A calculated sperm motility index value <0.75 was used to indicate sperm toxicity. It was found that optimum sensitivity (P < 0.01) of the human sperm motility assay was attained in the absence of albumin after 4, 8 and 48 h incubation periods. Items identified to be sperm toxic within 8 h by the human sperm motility assay were considered to be of clinical significance due to the close concordance of these results with mouse embryo development.

Hyperechogenic fetal bowel: a prospective analysis of sixty consecutive cases.

A two year prospective analysis of all second trimester fetuses (16-22 weeks of gestation) with hyperechogenic bowel was undertaken. Hyperechogenic fetal bowel (sonographic echogenicity similar to or greater than that of surrounding fetal bone) was diagnosed using strict criteria. Outcome of affected fetuses was ascertained from hospital records, health care workers and autopsy reports, up to six months of age. Sixty consecutive fetuses were identified, of which 48 (80%) were liveborn. Six pregnancies were terminated, four ended with an intrauterine fetal death and two died at birth. The incidence of cystic fibrosis and aneuploidy were each 5%, and there were no cases of congenital infection. Intrauterine growth retardation was recorded in six fetuses (10%), four of whom died perinatally. Eighty-two percent of fetuses (28/34) with isolated hyperechogenic bowel had a normal outcome.

The subjective assessment of echogenic fetal bowel.

OBJECTIVES: To assess the subjective interpretation of the echogenicity of fetal bowel compared to bone from antenatal ultrasound images taken during examinations conducted between 17 and 22 weeks of gestation. METHODS: Eighty-seven women attending for their antenatal scan were selected in a random prospective manner over a 9-month period. Images of the fetal bowel were taken and evaluated by 10 sonographers, one consultant obstetrician and one consultant radiologist. Images from a further 13 fetuses, in which the subjective assessment of echogenic bowel was made, were also included. All ultrasound images were acquired on a dedicated ultrasound scanner, with a standard transducer, thermal paper printer and single operator using standardized equipment settings and reproducible image sections. Questionnaires with 100 sets of images of fetal bowel were distributed to the participants. Performance was assessed by means of percentage agreement and levels of chance corrected agreement (Kappa). RESULTS: The subjective assessment of fetal bowel echogenicity is very variable. Intra- and inter-observer variation discrepancies in the assessment of bowel echogenicity compared to bone were demonstrated between the sonographers. Good agreement was identified between the consultants with good to almost perfect intra-observer agreement. Overall, only moderate agreement was observed between the sonographers and the consultants. CONCLUSIONS: The lack of agreement demonstrated between sonographers when evaluating the echogenicity of fetal bowel should be addressed if this ultrasound marker is to be incorporated into routine fetal screening programs.

Detection of concomitant formation of O6-carboxymethyl- and O6-methyl-2'-deoxyguanosine in DNA exposed to nitrosated glycine derivatives using a combined immunoaffinity/HPLC method.

A previous observation that an N-nitroso-N-carboxymethyl derivative reacts with DNA to give both O6-carboxymethyl-2'-deoxyguanosine (O6-CMdGuo) and O6-methyl-2'-deoxyguanosine (O6-MedGuo) [Shuker, D. E. G., and Margison, G. P. (1997) Cancer Res. 57, 366-369] has been confirmed using a range of nitrosated glycine derivatives [N-acetyl-N'-nitroso-N'-prolylglycine (APNG), azaserine (AS), and potassium diazoacetate (KDA)]. In addition, mesyloxyacetic acid (MAA) was also found to give both O6-adducts in DNA. O6-CMdGuo and O6-MedGuo were assessed in enzymatic hydrolysates of treated calf thymus DNA using a combined immunoaffinity/HPLC/fluorescence procedure. The ratio of O6-CMdGuo to O6-MedGuo varied somewhat between the different compounds with APNG giving the most methylation (O6-CM:O6-Me ratio of 10) and AS the least (39), with KDA and MAA giving intermediate amounts (16 and 18, respectively). The formation of O6-MedGuo by the four compounds probably arises through decarboxylation at various stages in the decomposition pathways, but the exact mechanisms remain to be clarified. The formation of O6-MedGuo from reactions of nitrosated glycine derivatives with DNA in vitro may explain the frequent detection of this adduct in human gastrointestinal DNA, as nitrosation of dietary glycine may occur. O6-CMdGuo is likely to be a useful biomarker of this pathway in vivo and has been detected in human tissues.

Evaluation of three substitutes for Percoll in sperm isolation by density gradient centrifugation.

Silane-coated silica particle solutions (ISolate(TM) and PureSperm)TM)) and iodixanol (OptiPrep(TM)) were compared to polyvinylpyrrolidone (PVP)-coated silica particles (Percoll(TM)) in their efficacy to recover spermatozoa by gradient centrifugation for use in assisted reproductive procedures. Efficacy was assessed in terms of percentages of sperm recovery, sperm vitality and motility, normal sperm morphology and normal sperm chromatin condensation. No significant difference was found in the recovery of spermatozoa for men with both normal sperm counts and oligozoospermia, between PVP-coated and silane-coated particle solutions. Iodixanol had significantly lower sperm recovery compared to the other products. Sperm vitality, progressive motility, normal morphology and normal chromatin condensation did not differ significantly between any of the sperm isolation products.

Synthesis, characterization, and immunochemical detection of O6-(carboxymethyl)-2'-deoxyguanosine: a DNA adduct formed by nitrosated glycine derivatives.

O6-(Carboxymethyl)-2'-deoxyguanosine (O6-CMdG) is formed in DNA by nitrosated glycine derivatives and appears to be nonrepairable by O6-alkylguanine transferases. O6-CMdG has been synthesized by an unambiguous route involving the introduction of a methyl glycolate moiety at C6 of a 3',5'-bis-O-(methoxyacetyl)dGuo derivative by displacement of a quinuclidinium ion. Methanolysis of the methoxyacetyl groups and calcium hydroxide-mediated hydrolysis of the methyl ester afforded the calcium salt of O6-CMdG in good yield. A similar route was used to synthesize O6-(carboxymethyl)guanosine (O6-CMGuo), which was used to prepare protein conjugates for immunization. Rabbit antisera were prepared, and a quantitative competitive ELISA was developed which showed 50% inhibition at 2 pmol of O6-CMdG/ well. O6-CMGuo was 30 times less cross-reactive (50% inhibition at 60 pmol/well), and normal nucleosides and carboxymethylated purines did not cross-react to any significant extent. The antiserum was also used to prepare reusable immunoaffinity columns which retained O6-CMdG. The binding of O6-CMdG was so strong that conditions used to elute the adduct (1 M trifluoroacetic acid) resulted in partial hydrolysis (becoming quantitative on heating) of the glycosidic bond to give O6-CMguanine which was detected by HPLC with fluorescence detection. DNA treated with azaserine (5 mmol), N-(N'-acetyl-L-prolyl)-N-nitrosoglycine (5 mmol), and potassium diazoacetate (5 mmol) afforded O6-CMdG at levels of 7.3, 393.9, and 496 mumol of O6-CMdG/mol of dG. The antiserum also recognized O6-CMdG in intact DNA.

Antiviral prophylaxis and the Epstein Barr virus-related post-transplant lymphoproliferative disorder.

Epstein Barr virus (EBV) infection has been associated with the post-transplant lymphoproliferative disorder (PTLD) in up to 8% of transplant recipients. Primary EBV infection and the use of antilymphocyte preparations appear to increase the incidence of PTLD. Experimental evidence suggests that the antiviral prophylaxis used by many transplant programs may influence the development of this post-transplant complication. In order to investigate the influence of antiviral prophylaxis (intravenous ganciclovir followed by high-dose oral acyclovir) on the development of PTLD in kidney-pancreas and liver allograft recipients from the University of Washington Medical Center, records were reviewed for pretransplant EBV status, antilymphocyte preparation use and for histologic documentation of PTLD. Two of 83 kidney-pancreas recipients (1 EBV-seronegative, 1 EBV-seropositive) and 1 of 123 liver recipients (EBV-seropositive) has developed PTLD. Six of 83 kidney-pancreas patients were EBV-seronegative prior to transplantation and 4 of these patients received at least two courses of an antilymphocyte preparation. Thirty-eight (49%) of the 77 EBV-seropositive kidney-pancreas recipients received at least two courses of an antilymphocyte globulin without the development of PTLD. Both the EBV-seronegative kidney-pancreas and the liver recipient who developed PTLD had received multiple courses of antilymphocyte globulins. One EBV-seropositive kidney-pancreas recipient had only received one course of OKT3 1 year prior to the development of PTLD. The incidence of PTLD reported here in patients receiving intravenous ganciclovir followed by high-dose oral acyclovir antiviral prophylaxis is lower than previously recorded when consideration is given for patient's EBV status and the use of antilymphocyte preparations.

Renal dysfunction due to an arteriovenous fistula in a transplant recipient.

Arteriovenous fistulae (AVF) occur after percutaneous renal biopsy in up to 18% of patients. Fistulae may remain asymptomatic or lead to hematuria, hypertension, and/or renal insufficiency. The identification of an AVF has traditionally been made with angiography; however, ultrasonography, which is less invasive and nonnephrotoxic, has become a valuable tool in the localization of a postbiopsy fistula. Most postbiopsy AVF are asymptomatic and close spontaneously. Conversely, AVF may enlarge and become symptomatic, requiring embolization to reverse or prevent complications. A case of renal insufficiency in a renal transplant recipient due to a postbiopsy AVF is presented. Spontaneous closure of the AVF resulted in the resolution of renal insufficiency. One must suspect an AVF when renal insufficiency occurs in an allograft after biopsy. Further study is needed to identify ultrasound characteristics that will predict the natural history of postbiopsy AVF.

De novo amyloidosis in a renal allograft: a case report and review of the literature.

Recurrent amyloidosis is an uncommon but well-documented event in up to 26% of renal allograft recipients transplanted for amyloid renal disease. Both primary and secondary amyloidoses recur. De novo primary and secondary amyloid have not been previously reported. We report the first occurrence of de novo secondary amyloid in a renal allograft recipient. The cause of the secondary amyloidosis is unproven, but possible etiologies include inflammation secondary to occult hepatitis, rheumatoid arthritis, or chronic rejection. Colchicine therapy has not resulted in decreased proteinuria or improved renal function.

Embryotoxicity of micropore filters used in liquid sterilization.

Microfiltration is the usual method of sterilization of tissue culture media. The filtrates of eight commercial filters were tested for embryotoxicity using mouse embryo growth. Four of five disk filters tested showed embryo-toxicity in the first 5 ml of filtrate and the three larger-capacity filters showed embryotoxicity for up to the first 10 ml of filtrate. The ethylene oxide-sterilized filters appeared to give poorer results than the gamma-irradiated filters. The importance of discarding the initial filtrate or preflushing such filters before use is emphasized.

The effect of patient smoking habit on the outcome of IVF and GIFT treatment.

The outcomes of 650 patients, 108 of whom were smokers, receiving assisted reproduction treatment were assessed for the effects of smoking habit on ovulation, fertilization, implantation and pregnancy outcome. Smokers produced fewer oocytes, gave a pregnancy rate less than half that of the nonsmokers, and those smokers who became pregnant showed a markedly increased rate of miscarriage.